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Choose, from the following X-Rays, the dental development stage which corresponds to the identified tooth.
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DENTAL CALCIFICATION
The assessment of DENTAL CALCIFICATION, a refined scale for the evaluation of development, is based on shape changes in the dentition and therefore requires the use of a radiograph.
When the study of dental development is based on emergence (commonly confused with eruption), it is necessary to assess the clinical appearance of a tooth (i.e., the time when the tooth first pierces the gingival tissue).
The two primary disadvantages of using dental emergence when evaluating dental development are:
a) The difficulty and subjectivity in assessing the exact timing of dental emergence.
b) The lack of concensus in the literature concerning the exact definition of emergence.
The assessment of emergence is further limited by:
a) Dental Impaction - while impacted teeth continue to develop (calcify)
normally in the alveolar bone, their emergence cannot be evaluated.
b) Dental Crowding - crowding is associated with abnormal patterns of
emergence, even though calcification proceeds normally.
Dental maturation is assessed on a panoramic dental radiograph.
Periapical films can also be used for this purpose, if a panoramic X-Ray machine is not available. With a panorex film, the mandibular teeth on the left side are used for the ratings.
Separate criteria have been developed for UNIRADICULAR and MULTIRADICULAR teeth.
RATING OF DENTAL MATURATION
The permanent mandibular teeth of the left side are used for the ratings. If a tooth is missing, the corresponding tooth from the right-hand side is used.
The following order of assessment should be observed:
1) Second molar,
2) First molar,
3) Second bicuspid,
4) First bicuspid,
5) Cuspid,
6) Lateral incisor,
7) Central incisor.
All teeth are rated on a scale from 0 (A) to 8 (H).
Scores are assigned by comparing the tooth to the definition, the graphics and the X-Ray image of each stage.
The descriptions should be closely followed; the images are intended to serve as an aid, not as the primary basis for making comparisons.
The letters are added to show that on a chronological time scale, the stages are not equidistant from one another.
A stage may be defined by one (1), two (2), or three (3) criteria.
If only one criterion is given, it must be met in order to
consider that the stage has been attained.
If two criteria are given, then it is sufficient if the first of
the two is met.
If three criteria are given, any two of the three must be
met in order for the stage to be considered attained.
In addition to the criteria for each stage, all those of the previous stage(s) must have been satisfied as well.
The earlier of two stage should be assigned in borderline cases. Absolute measure-ments are not used in the assessments.
A pair of dividers is sufficient for the comparison of the lengths of the crown and root. Magnification is not necessary to determine apex closure stages; ratings should be made with the naked eye.
Crown height is defined as the maximum distance between the highest tip of the cusps and the cemento-enamel junction.
The midpoint between buccal and lingual cusps should be considered to beat the highest point when the cusps are not at the same level.
considered to be
at the highest point when the cusps are not at the same level.
DEVELOPMENTAL STAGES:
Uniradicular Teeth
Multiradicular Teeth
Demirjian System
Dental Calcification
Demirjian System
Dental Calcification
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This chapter is designed to test your newly acquired knowledge of dental development.
It consist of 54 different X-Rays taken from 6 patients: 3 boys and 3 girls. These X-Rays were taken yearly between the ages of 6 and 14 years old.For each X-Ray shown, 7 teeth are indentified, for which you will be asked to choose the corresponding dental developmental stage.
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From here you will choose an X-Ray from one of the 6 patients; for each X-Ray, you will evaluate the 7 teeth (37,36,35,34,33,32,31), one after the other.
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Bibliography
Indexental Calcification
Bibliography
Indexl Calcificationtion
CLICK ON THE ABSTRACT OF YOUR CHOICE...
1. A new system of dental age assessment, 1973.
2. Dental age estimation of children in forensic odontology, 1975.
3. New systems of dental maturity based on seven and four teeth, 1976.
4. Dentition in: Human Growth (1st ed.), 1978.
5. Dental development of British and French-Canadian children, 1979.
6. Dental development: A measure of physical maturity, 1980.
veloppement dentaire: Indice de maturit
physiologique, 1980.
8. The inter-examiner variation in rating dental formation from radiographs, 1980.
9. Sexual differences in dental development and prediction of emergence, 1980.
10. Sexual dimorphism in the development, emergence of the mandibular third molar, 1981.
11. L'
mergence des dents pr
molaires chez l'enfant canadien-fran
ais, 1981.
12. Teeth and dentition, 1984.
13. Sexual dimorphism in the emergence of the deciduous teeth, 1984.
14. Interrelationships among measures of somatic, skeletal, dental and sexual maturity, 1985.
15. Croissance et d
veloppement physique de l'enfant qu
cois de la naissance
six ans, 1985.
16. Dentition in: Human Growth (2nd ed.), 1986.
17. Sexual dimorphism in the emergence of deciduous teeth, 1986..86.
By clicking on a title, you will get an abstract of that article.
valuationClinique
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Clinical Evaluation
tal Calcification
Clinical Evaluation
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You have to specify the sex of the patient,
the developmental stage of each of the 7 tooth.
Maturit
You have to specify the sex of the patient,
the Maturity Score.
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Stades
RATES DENTAL AGEEE
Dental Age:
Score:
Score
Age dentaire
Second Molar:ar
First Molar::l Age:
Second Premolar:ge:
First Premolar:Age:
Canine:Molar:l Age:
Lateral Incisor:ge:
Central Incisor:ge:
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B V&m
Maturit
MATURITY SCORE DENTAL AGE
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:core:
Age dentaire
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Article
Article
Droite
Gauche
Dental age estimation of children in forensic dontology.
Dental Age/Dental Maturity
Demirjian A.
Forensic Science
5 to 1211
211-227777
This article shows the applications of using dental age and the use of dental age in forensic medicine, dentistry and anthropology.
e use of dental ag
e in forensic medicine, dentistry and anthropology.
e in forensic medicine, dentistry and anthropology.
ations of using dental age and the use of dental ag
e in forensic medicine, dentistry and anthropology.
hropology.
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Article
Article 9
(PART I)
Reprinted from Journal of Dental Research July 1980
Sexual Differences in Dental Development and Prediction of Emergence
A. DEMIRJIAN and G.-Y. LEVESQUE
Human Growth Research Centre, Universit
de Montr
al, 2801 Edouard-Montpetit, Montr
al, Qu
bec, Canada H3T 1J6
The dental development of a genetically homogeneous French-Canadian group of children ranging in age from 2.5 to 19 years was evaluated from 5,437 panoramic radiographs by the method of Demirjian et al.8 The maturity of each tooth was evaluated individually. For each stage of each tooth developmental curves of boys and girls were compared. A common pattern was found for each tooth, namely the chronological similarity between boys and girls in the early stages of development, and the advancement of girls over boys for the later stages. Developmental scores were given to the seven mandibular teeth. Up to five to six years of age, no difference was found in the timing of dental development between boys and girls, in contrast to the older ages where girls were always more developed than boys. When the emergence curve was plotted with developmental curves a close relation was established between the stage of formation of all teeth and their emergence, hence the predictive value of the use of dental maturity curves in clinics.
J. Dent. Res. 59(7):1110-1122, July 1980
partie2
Part II
partie1
Part I
Imprimer
Print
Index
Index
Tables & Graphs
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veloppement dentaire: indice de maturit
physiologique.
Dental Maturity
Demirjian A.
Union M
dicale du Canada
109: 832 to 839
A review, in French, of the many applications of dental development in Human Growth.
A review, in French, of the many applications of dental development in Human Growth...
The inter-examiner variation in rating dental formation from radiographs.
Dental Formation
vesque G.Y., Demirjian A.
Journal of Dental Research
59: 1123 to 11266icle deals with the statistical analysis of the variability of inter- and intra-
examiner evaluations of dental radiographs for dental formation.
This article deals with the statistical analysis of the variability of inter- and intra- examiner evaluations of dental radiographs for dental formation...
Sexual difference in dental development and prediction of emergence
Dental Maturity
Demirjian A. & L
vesque G.Y.,
J.Dent. Res.
59: 1110 a very practical publication, mostly for clinical use.
This is a very practical publication, mostly for clinical use.
Sexual dimorphism in the development, emergence and agenesis of the mandibular third molar.
Dental Formation
vesque G.Y., Demirjian A.
Journal of Dental Research
60: 1735 to 17411ehensive study of the mandibular third molar with a very large sample size.
A comprehensive study of the mandibular third molar with a very large sample size.
mergence des dents chez l'enfant canadien-fran
Dental emergence
Lauzier C. & Demirjian A.
Union M
dicale du Canada
10: 375 to 3822f deciduous dentition.
The sample size is close to 500.
The first study in French Canada on the timing of the emergence of deciduous dentition. The sample size is close to 500..
Teeth and Dentition
Dental Maturity
Demirjian A.
Human Growth and Development
J.Borms et al., Planum: New York
327 to 3344e review of dental development and emergence.AAAAAAAAA
A comprehensive review of dental development and emergence.
Sexual dimorphism in the emergence of the deciduous teeth.
Dental emergence
Tanguay R., Demirjian A., Thibault H.W.
Journal of Dental Research
63: 65 to 68
A longitudinal study from birth to six years. The emergence of the deciduous teeth have been observed and recorded by parents..
Interrelationships between somatic, skeletal, dental and sexual maturity.
Physical growth and maturation.
Demirjian A. et al.
Am. J. of Orthodontics
88: 433 to 4388of different maturity indicators.
A good review of different maturity indicators.
Croissance et d
veloppement physique de l'enfant qu
becois de la naissance
six ans.
Somatic Growth of French Canadian children.
Arto Demirjian
Book published by: Les Presses de l'Universit
de Montr
28000 a collection of data on a longitudinal growth study of French Canadian children between birth and 6 years. Graphs and tables illustrate the somatic, skeletal and dental development of the children. There are also chapters on nutrition and motor skills.......
This book is a collection of data on a longitudinal growth study of French Canadian children between birth and 6 years. Graphs and tables illustrate the somatic, skeletal and dental development of the children. There are also chapters on nutrition and motor skills.
Dentition in: Human Growth.
A comprehensive treatise.
Dental calcification and emergence
A. Demirjian
F.Falkner & J.Tanner Plenum,
New York (2nd Ed.)
12: 269 to 295ve review of every aspect of dental development and emergence.
A very complete review of literature on the subject. Detailed information on Demirjian's method of dental age assessment...
A comprehensive review of every aspect of dental development and emergence.
A very complete review of literature on the subject. Detailed information on Demirjian's method of dental age assessment.
Sexual Dimorphism in the emergence of deciduous teeth: its relationship with growth components in height.
Dental emergence
Tanguay R., Buschang P.H., Demirjian A.
Am. J. Physical Anthropology
69: 511 to 5155cle highlights the differences among boys and girls for the chronology of the deciduous dentition's emergence. The relationship between dental emergence and height is also discussed for both sexes....
This article highlights the differences among boys and girls for the chronology of the deciduous dentition's emergence. The relationship between dental emergence and height is also discussed for both sexes.
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Article1
eArticle 1
A New System of Dental Age Assessment
By A. Demirjian, L. H. Goldstein2,3 and J. M. Tanner2
Abstract:
A new method is given for estimating dental maturity or dental age, by reference to the radiological appearances of the 7 teeth on the left side of the mandible. Panoramic radiographs of 1446 boys and 1482 girls of French Canadian parentage have been used. Each tooth has been rated according to developmental criteria (amount of dentinal deposit, shape change of the pulp chamber, etc.) rather than changes in size. Eight stages, A to H, have been defined from the first appearance of calcified points to the closure of the apex. The method of Tanner, Whitehouse and Healy for skeletal maturity has been used for deriving a score for each stage of each tooth. The summed scores on all seven teeth give a dental maturity score which can be converted directly into a dental age. In case of missing teeth, the possibility of using combinations of different teeth is discussed.
Although the maturity scoring system is probably universal in application, the conversion to
dental age, or the location of the centiles for maturity at given ages, depends on the population
considered. The present system is applicable from age 3 to 17; we hope to extend it to younger
ages as material accumulates.
1. Centre de Recherches sur la Croissance, Universit
de Montr
2. Departement of Growth and Development, Institute of Child Health, University of London, London W.C.I.
The concept of physiological age is based upon the degree of maturation of different tissue systems. Several biological ages have been developed: skeletal age, morphological age, secondary sex character age and dental age. These criteria can be applied separately or together to assess the degree of physiological maturity of a growing child.
Dental age is of particular interest to the orthodontist in planning the treatment of different types of malocclusions in relation to maxillo-facial growth. It can also be a help in determining the age of cadavers or in skeletal material where other parts of the body are missing. In pediatric endocrinopathies the diagnosis and the results of treatment may sometimes be better evaluated if dental age is assessed in parallel with other maturity indicators.
Until quite recently, clinical eruption has been the only criterion used for dental maturity or dental age (Bean 1914; Beik 1913 and Catell 1928). Norms derived from Logan and Kronfeld's data (1933), as modified by Schour and Massler (1940), as well as from Hurme's (1949) and Clements, Davies-Thomas and Pickett's (1957) data have been used extensively. The timing of eruption of the permanent teeth in relation to race and sex has been studied by several authors (Carr 1962: Clements et al. 1957; Dahlberg and Maunsbach 1948-50; Halikis 1961; Houpt et al. 1967: Hurme 1949; Knott and Meredith 1966; Nanda 1960; Steggerda and Hill 1942; Stones et al. 1951). Different criteria have been used for tooth eruption, from gingival emergence to occlusal contact with the opposing teeth.
Gingival emergence, wich is often erroneously called eruption, represents only one stage in the continuous process of denntal eruption, or migration to reach the occlusal level. Emergence may be influenced by local factors: ankylosis, early or delayed extraction of the deciduous tooth, impaction and crowding of the permanent teeth (Fanning 1961; McDonald 1969; Posen 1965). In contrast, formation rate of the permanent teeth is not affected by premature loss of the deciduous teeth (Fanning 1962; Sapoka and Demirjian 1971). Furthermore if clinical emergence is used as the criterion for dental age assessment, it can only be applied up to the age of 30 months (completion of the deciduous dentition) and after the age of 6 years (eruption of the first molar).
Several authors have investigated the association between emergence and root formation (Brauer and Bahador 1942; Garn and Lewis 1957; Gleiser and Hunt1955; Gr
n1962; Haavikko 1970; Shumaker and El Hadary 1960). Different definitions of formation and "eruption" have been used. Visible emergence usually occurs when root formation is about three quarters complete, but quite large departures from this rule have been observed. Furthermore, the association between emergence and formation varies between different teeth. Recently Liliequist and Lundberg (1971) have investigated a scoring system for maturity, and Fanning (1971) has initiated a multivariate analysis approach. These studies have led to the conclusion that tooth formation is a more reliable indicator of dental maturity than gingival emergence or "eruption".
The construction of a maturity scale.
In order to study dental formation, different developmental stages have been defined by several authors (Fanning 1961; Garn and Lewis 1957; Gleiser and Hunt 1955; Moorrees et al. 1963; Nolla 1960). These stages have usually been marked by recognisable tooth shapes, from the beginning of calcification through to final mature form. Useful stages must be easily recognisable, and such that a tooth always passes through the same stages in every individual. Since the stages are indicators of maturity and not of size they cannot be defined by any absolute length measurements. After study of both longitudinal and cross-sectional material we have adopted the stages described and illustrated in the appendix (Figure 1). There are eight stages, A to H, for each tooth together with stage 0 for non-appearance.
The purpose of the present study is to derive a method of estimating overall dental maturity or dental age by a quantity based on the stages observed in each tooth. This problem occurs in defining any other kind of maturity, for example skeletal maturity based on the bones of the and wrist. Two general approaches have been advocated. One of these, the Atlas approach (Greulich and Pyle 1959) sets out a typical 'profile' of stages at each of a series of ages over the age range being studied. Any new set of ratings is then compared with these profiles until the best matching one is found and the corresponding age then becomes the estimate of skeletal or dental age. The other approach (Tanner, Whitehouse and Healy 1962) is to give each bone, or tooth, a score depending on its stage. The scores on all the teeth are then added together to give a total maturity score which can be converted directly into a dental age using an appropriate table of standards.
A method for deriving the scores and its justification is described in Tanner et al. (1962) in relation to skeletal age. It is this method which we have adopted. A relatively minor methodological revision has recently been made in this technique (Tanner et al. 1973) and we have used this revised form. In it the final scores for each tooth, previously constrained each to be lOO are allowed to vary so that only their sum (or average) over all the teeth is 100. This makes allowance for the different ages at which different teeth reach maturity. Girls and boys are given different systems of scores.
Material and methods
The data (Table l) consist of panoramic radiographs of the teeth of 1446 boys and 1482 girls aged 2 to 20, examined in the Ste-Justine Hospital and the Growth Centre, Montreal (Demirjian et al. 1971). We took radiographs only from children free from any disorder affecting growth and who had a complete mandibular permanent dentition (erupted or not). All had parents and grand-parents of French-Canadian origin. Panoramic radiographs were used because they are easier to make than intraoral radiographs in young or nervous children; they give less radiation for a full mouth radiograph (McDonald 1969) and the picture of the mandibular region they produce is little distorted. Though there is 3 to 10% enlargement on the left side of the mandible (Sapoka and Demirjian 1971) this is not a serious drawback, because our rating system is based on shape criteria and relative values rather than on absolute lengths. The radiographs were rated by four examiners all trained by one of them. Each examiner rated the same percentage of radiographs of each age group. At the end of each day, five randomly chosen X-rays were reassessed by each examiner, results were compared and any discrepancies were discussed. Disagreement between examiners occurred in no more than 10% of films and was never more than one stage.
Results
The analysis of the individuals' ratings, in the manner described by Tanner et al. (1973) led to the maturity scores given in Table 2 (in appendix). Girls and boys were treated separately, because this allows for sex-tooth interaction, that is for one tooth being relatively more advanced in one sex than in the other.
This is known to occur in tooth eruption, and appears also in our scores, since they are higher for girls than boys in all teeth exccept Ml where girls are lower. The analysis gives a set of scores, one for each stage of each tooth (Table 2). These are then added together for a particular individual set, to give a maturity score for that individual. This maturity score is then referred to the centile chart or to Table 3 (in appendix) for conversion to a dental age. (See Appendix for details).
The centile curves (Figures 2 and 3) have been plotted exponentially, since this scale leads to better visual presentation than a linear scale. Though not symmetrical at either end, the centile lines still have a visible space between them rather than converging to a tiny area as they would in a linear presentation. The centile distribution is symmetrical at about age 71/2 in both sexes.
Discussion
In one sense the results presented here are preliminary ones, because the full range from immaturity to maturity is not covered. Among the youngest groups of children there are insufficient numbers to provide accurate estimates of maturity centiles and dental age, although the numbers are sufficient to provide good estimates of the maturity scores. Thus the centile charts only run from three to seventeen years and it is intended to extend them when data become available.
We initially used all fourteen lower mandibular teeth in the scoring system. It is well known however that a very high degree of symmetry exists betweenl the left and right side teeth, and we therefore investigated whether a seven tooth system using one side only would give almost the same estimate as one using all fourteen teeth. We calculated separate fourteen and seven tooth systems, the seven teeth being taken from the left side. For each child we estimated the dental age on each system and then took the difference in dental ages between the two systems. Perfect agreement between the systems would be indicated by a constant difference at each age. The variation of the difference can be used as a measure of how much the systems differ. The standard deviation of the difference between fourteen and seven tooth systems was small, being about three weeks at eight years of age, compared to a standard deviation of the dental age on either system of about six months. It thus appears that the seven tooth system is acceptable and we have used the seven teeth on the left side as the basis of our system.
In the bone age system, different "biological" weights are attached to the bones so as to allow for the three phalanges in a finger giving very similar information, and swamping, for example, the metacarpal (Tanner et al. 1973). We have tried several "biological" weighting systems of this sort and find that they make very little difference to the resulting estimates. The standard deviation of the differences in dental ages are about the same as that found between the fourteen tooth and seven tooth systems. For simplicity we have therefore given each tooth equal weight.
In contrast to the situation in the bones of the hand and wrist, a particular child may have one or more teeth missing. The question then arises as to whether the remaining teeth may be used to give a maturity estimate. Where the teeth corresponding to those missing are present on the right side of the lower mandible they may be simply substituted. Where this is not the case,
however, there are two possible approaches. Either we may try to "estimate' a score for the missing tooth or we may use a scoring system based only on those teeth present.
The first possibility is unsatisfactory for the following reasons. If, for example, just one tooth is missing wecould attempt to estimate it by inserting the average score over the other six teeth. If the missing tooth always tends to be the same one, this procedure will lead to a biased estimate at any particular age. If teeth are missing uniformly at random, then although the maturity score estimate will be unbiased, the variability will be greater than the corresponding score based on seven teeth. so that the seven tooth centile limits will be too narrow.
The second method avoids these drawbacks, but it does imply that a separate system has to be calculated and published for each combination of less than seven teeth. Howcver, it might be practicable to do this for some of the most commonly found combinations. We have therefore investigated the six tooth system obtained by missing out the first molar. Using the same measure of difference as before, we find that at age eight, the standard deviation of the difference in dental age between the two systems is as much as five weeks. It therefore seems questionable as to whether the two systems are in fact estimating the same thing. By leaving out a tooth we may be measuring a slightly different aspect of maturity. This, taken along with the difficulty of supplying separate systems for all the most common combinations has led us to abandon the attempt for the time being. However, as more data accumulate we do intend to pursue this problem further.
We have similarly studied 4-tooth systems ( M2, Ml, Pm2, Pml and M2, Pm2, Pm1, Il ) which form a convenient group of teeth for rating purposes. We find, at age eight, a standard deviation of the difference in dental ages of about ten weeks, and at higher ages, the distribution so tends to become bimodal.
In using the maturity standards given in Table 3 of this paper, it should be remembered that the sample on which they are based is entirely of French Canadian origin. The dental maturity scores for given chronological age may well be greater or less in other populations, according as to whether they are more or less dentally advanced during growth.
It seems reasonable to assume however, that the pattern of development of the teeth will not vary very much in different populations, so that the scores of Table 2 for the stages should be similar in other populations. The differences will arise only when these are converted to a dental age. We therefore recommend our maturity scoring system as a valid measuring instrument for universal use. Furthermore, with the use of relatively small local samples, and by comparison with our Table 3, dental age equivalents could readily be estimated for different populations.
Acknowledgements
The authors express their appreciation to Drs. H. Gr
goire, Head of Department of Radiology and G. Albert, Head of Department of Dentistry, Ste-Justine's Hospital for kindly providing part of the radiographs used in the study: Drs. A. Sapoka, G. Beiger and Mr. L. Monday for their criticism and evaluation of the material, and Mr. M. J. R. Healy, Mr. R.H. Whitehouse, and Dr. W.A. Marshall for helpful comments on the manuscript. We acknowledge with thanks the support of the Nuffield Foundation, The Canadian Medical Research Council and the Departement of National Health and Welfare of Canada Grant No. 604-7-563
References
BEAN, R. B. 1914 Eruption of teeth as physiological standard for testing development. Pedagog. Sem. 21: 596-614.
BEIK, A. K. 1913 Physiological age and school entrance. Pedagog. Sem. 20: 283-303.
BRAUER, J. C. and M. A. BAHADOR 1942 Variations in calcification and eruption of the deciduous ad the permanent teeth.
J. Am. Dent. Assoc. 29: 1373-1387.
CARR, L. M. 1962 Eruption ages of permanent teeth. Austr. Dent. J. 7: 367-373.
CATELL, P. 1928 Dentition as measure of maturity. Cambridge: Harvard University Press. Harvard Monographs in Education,
No. 9.
CLEMENTS, E. M. B., E. DAVIES-THOMAS, AND K. G. PICKETT 1957 Time of eruption of permanent teeth in British children
at independent, rural, and urban schools. Brit. Med. J. 1511-1513.
DAHLBERG A. A. and B. MAUNSBACH 1948 The eruption of the permanent teeth in the normal population of Sweden. Acta.
Genet. 1: 77-91.
DEMIRJIAN A., M. B. DUBUC, and M. JENICEK 1971
tude comparative de la croissance de l'enfant canadien d'origine
fran
aise
Montr
al. Can. J. Publ. Health. 62: 111-119.
FANNING E. A.
-1961 A longitudinal study of tooth formation and root resorption.New Zealand. Dent. J. 57: 202-217.
-1962 Effect of extraction of deciduous molars on the formation and eruption of their sucessors. Angle Orthodont. 32: 44-53.
-1971 Primary and permanent tooth development. Austr. Dent. J. 16: 11 - 13.
GARN S. M. and A. B. LEWIS 1957 The relationship between the sequence of calcification and the sequence of eruption of
the mandibular molar and premolar teeth. J. Dent. Res. 36: 992-995.
GLEISER,I. and E.E. HUNT1955 The permanent mandibular first molar: its calcification, eruption and decay. Am. J. Phys.
Anthrop. N. S. 13: 253-284.
GREULICH, W.W. and I. PYLE 1959 Radiographic atlas of skeletal development of the hand and wrist. 2nd Ed. Stanford Univ.
Press, Stanford.
N, A. M. I962 Prediction of tooth emergence. J. Dent. Res. 41: 573-585.
HAAVIKKO, K. 1970 The formation and the alveolar and clinical eruption of the permanent teeth. Suom. Hammaslaak. Toim.
66: 107-152.
HALIKIS, S. E. 1961 The variability of eruption of permanent teeth and loss of deciduous teeth in Western Australian Children.
1. Times of eruption of the permanent teeth. Austr. Dent. J. 6: 137-140.
HOUPT, M.S.I. ADU-ARUEE, and R. M. GRAINGER 1967 Eruption times of permanent teeth in the Brong Ahafo Region of
Ghana. . Am. J. Orthod. 53: 95-99.
HURME, V. 0. 1949 Ranges of normalcy in the eruption of permanent teeth. J. Dent. Child. 16: 11-15
KNOTT, V. B. and H. V. MEREDITH 1966 Statistics on eruption of the permanent dentition from serial data for North American
White Children. Angle Orthod. 36: 68-79.
LILIEQUIST, B., and M. LUNDBERG 1971 Skeletal and tooth development; a methodologic investigation. Acta. Radiol.
11: 97-ll2.
LOGAN, W. H. G., .and R. KRONFELD 1933 Development of the Human Jaws and surrounding structures from birth to the age
of fifteen years. J. Am. Dent. Assoc. 20: 379-427.
McDONALD, R. E. 1969 Dentistry for child and adolescent. C. V. Mosby, St.-Louis.
MOORREES, C. F. A., E. A. FANNING, and E. E. HUNT JR. 1963 Age variation of formation stages for ten permanent teeth.
J. Dent. Res. 42: 1490-1502.
NANDA, R. S. 1960 Eruption of human teeth. Amer. J. Orthodont. 46: 363-378.
NOLLA C.M. 1960 The development of the permanent teeth. J. Dent. Child. 27: 254-266.
POSEN, A. L. 1965 The effect of premature loss of deciduous molars on premolar eruption. Angle Orthod. 35: 249-252.
SAPOKA, A. M. and A. DEMIRJIAN 1971 Dental development of the French Canadian child. J. Can. Dent. Assoc. 37: 100-104.
SCHOUR, I. and M. MASSLER l940 Studies in tooth development: The growth pattern of human teeth. II. J. Am. Dent. Assoc.
27:1918-1931.
SHUMAKER, D. B. and M. S. EL HADARY 1960 Roentgenographic study of eruption. J. Am. Dent. Assoc. 61: 535-541.
STEGGERDA, M. and T. J. HILL 1942 Eruption time of teeth among whites Negroes and Indians. Am. J. Orthod. 28: 361-370.
STONES, H. H., F. E. LAWTON, E. R. BRANSBY, and H. 0. HARTLEY 1951 Time of eruption of permanent teeth and time of
shedding of deciduous teeth. Brit. Dent. J. 90: 1-7.
TANNER, J. M. 1962 Growth at adolescence. 2nd Edition. Blackwell Scientific Publications, Oxford.
TANNER, J. M., R. H. WHITEHOUSE, and M. J. R. HEALY 1962 A new system for estimating skeletal maturity from the hand
and wrist, with standards derived from a study of 2,600 healthy British children. Centre International de l'Enfance, Paris.
TANNER, J. M., R. H. WHlTEHOUSE, W. A. MARSHALL, M. J. R. HEALY, and H. GOLDSTEIN
1973 A revised (TW2) system for estimating skeletal maturity from haand and wrist radiographs. In preparation.
APPENDIX
Assigning the ratings
1. The mandibular permanent teeth are rated in the following order: 2nd molar, 1st molarr, 2nd bicuspid, 1st bicuspid, canine,
lateral incisor, central incisor.
2. All teeth are rated on a scale A to H. The rating is assigned by following carefully the written criteria for each stage, and by
comparing the tooth with the diagrams and X-ray pictures given in Figure 1. The illustrations should only be used as an aid,
not as the sole source of comparison. For each stage there are one, two or three written criteria marked a), b), c). If only
one criterion is given this must be met for the stage to be taken as reached; if two criteria are given, then it is sufficient if
the first one of them is met for the stage to be recorded as reached; if three criteria are given, the first two of them must be
met for the stage to be considered reached. At each stage, in addition to the criteria for that stage, the criteria for the
previous stage must be satisfied. In borderline cases the earlier stage is always assigned.
3. There are no absolute measurements to be taken. A pair of dividers is sufficient to compare the relative length
(crown/root). To determine apex closure stages no magnifying glass is necessary. The ratings should be made with the
naked eye.
4. The crown height is defined as being the maximum distance between the highest tip of the cusps and the cemento-enamel
junction. When the buccal and lingual cusps are not at the same level, the midpoint between them is considered as the
highest point.
Dental Formation Stages
If there is no sign of calcification, the rating 0 is given. The crypt formation is not taken into consideration.
Stage description
A In both uniradicular and multiradicular teeth, a beginning of calcification is seen at the superior level of the crypt in the
form of all inverted cone or cones. There is no fusion of these calcified points.
B Fusion of the calcified points forms one or several cusps which unite to give a regularly outlined occlusal surface.
C a. Enamel formation is complete at the occlusal surface. Its extension and convergence towards the cervical region is
seen.
b. The beginning of a dentinal deposit is seen.
c. The outline of the pulp chamber has a curved shape at the occlusal border.
D a. The crown formation is completed down to the cemento-enamel junction.
b. The superior border of the pulp chamber in the uniradicular teeth has a definite curved form, being concave towards
the cervical region. The projection of the pulp horns if present, gives an outline shaped like an umbrella top. In molars
the pulp chamber has a trapezoidal form.
c. Beginning of root formation is seen in the form of a spicule.
E Uniradicular teeth:
a. The walls of the pulp chamber now form straight lines, whose continuity is broken by the presence of the pulp horn,
which is larger than in the previous stage.
b. The root length is less than the crown height.
Molars:
a. Initial formation of the radicular bifurcation is seen in the form of either a calcified point or a semi-lunar shape.
b. The root length is still less than the crown height.
F Uniradicular teeth:
a. The walls of the pulp chamber now form a more or less isosceles triangle. The apex ends in a funnel shape.
b. The root length is equal to or greater than the crown height.
Molars:
a. The calcified region of the bifurcation has developed further down from its semi-lunar stage to give the roots a more
definite and distinct outline with funnel shaped endings.
b. The root length is equal to or greater than the crown height.
G a. The walls of the root canal are now parallel and its apical end is still partially open (Distal root in molars).
H a. The apical end of the root canal is completely closed. (Distal root in molars).
b. The periodontal membrane has a uniform width around the root and the apex.
Using the Scoring System
1. Each tooth will have a rating assessed by the procedure described.
2. This is converted into a score using Table 2 for boys or girls as appropriate.
For example if tooth Ml of a boy is in stage E it is given a score 9.7.
3. The scores for all seven teeth are added together to give the maturity score.
4. The maturity score may be plotted on the centile charts (boys or girls as appropriate) where the age of the child is known.
For example a score of 35 for a boy aged 5.0 years lies just above the 90th centile.
5. The maturity score may be converted directly into a dental age either by reading off on the horizontal scale the age at
which the 50th centile attains that maturity score value, or by using Table 3 which has been constructed by this means.
Thus a score of 45 for a boy is equivalent to a dental age of 6.9 years.
A) The walls of the pulp chamber have changed to form straight lines whose continuity
is broken by the presence of the pulp horn, which has enlarged since stage 4.
B) The root length is less than the crown height. (Note: Criteria A must be met for this
stage to have been attained.)d like the top of an umbrella.
C) The beginning of root formation can be seen in the form of a spicule.
This text gives you the caracteristics and particularities of each stages...ticle.
Demirjian System
Dental Calcification
Demirjian System
Dental Calcification
The arrow buttons are used to pass through the stages on by one longitudinally, to the right or the left.
...while the images below present the same stage in 3 different ways:
a diagram, an X-Ray and a specimen.
These buttons indicates which developmental stages you are viewing; you can also jump from one stage to another by clicking on them.
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A new system of Dental Age assessment
Dental Maturity
A. Demirjian, H. Goldstein & J.
Human Biology vol.45
211 to 2277
This is the first article written on the evaluation of DENTAL AGE, describing DEMIRJIAN's system.
A2---
Dental age estimation of children in forensic odontology.
Dental Age/Dental Maturity
Demirjian A.
Forensic Science
5:121
This article shows the applications of using dental age and the use of dental ag
e in forensic medicine, dentistry and anthropology.
hropology.
Dental age estimation of children in forensic dontology.
Dental Age/Dental Maturity
Demirjian A.
Forensic Science
5 to 1211
211-227777
This article shows the applications of using dental age and the use of dental age in forensic medicine, dentistry and anthropology.
e use of dental ag
e in forensic medicine, dentistry and anthropology.
e in forensic medicine, dentistry and anthropology.
ations of using dental age and the use of dental ag
e in forensic medicine, dentistry and anthropology.
hropology.
New systems of Dental Maturity based on seven and four teeth
Dental Maturity
A. Demirjian & H. Goldstein
Ann. Hum. Biol.
3 to 411
is article, a follow up to the original of 1973, one will find a second approach to
Dental Age evaluation. A system using four teeth (Pm1, Pm2, M1, M2) has been added.
In this article, a follow up to the original of 1973, one will find a second approach to
Dental Age evaluation. A system using four teeth (Pm1, Pm2, M1, M2) has been added.
Article11
aideEntrainement3
Dentition in: Human Growth.
A comprehensive treatise.
Dental calcification and emergence
A. Demirjian F.Falkner & J.Tanner
Plenum, New York (1st Ed.)
-sive review of every aspect of Dental age and emergence. A very complete revi
ew of the literature on the subject. Detailed information on Demirjian's method of denta
l age assessment.
A comprehensive review of every aspect of Dental age and emergence. A very complete review of the literature on the subject. Detailed information on Demirjian's method of dental age assessment.....
Dental development of British and French Canadian children.
Dental Maturity
A. Demirjian & C. Lamarche
Proc.of the first Int. Congress of Auxology.
This is a comparative study of the Dental age of two populations, British and French Canadian.. Lamarche
Proc.of the first Int. Congress of Auxology.
This is a comparative study of the Dental age of two populations, British and French Canadian...
Article17
TG6_2
TG6_6
Dental Development: a measure of Physical growth and maturation.
Dental Maturity
Demirjian A.
NATO Advanced Study Institute Series.
83 to 100
This is one of the articles published in the proceedings of a NATO conference held in Urbino, Italy in 1979.
Edited by:
Johnston F.E., Roche A.F., and Suzanne C..........s published in the proceedings of a NATO conference held in Urbino, Italy in 1979. Edited by: Johnston F.E., Roche A.F., and Suzanne C...
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The beginning of calcification may be seen in the
form of inverted cone(s) at the superior level of the crypt.
Fusion of these calcified points has not yet occurred.
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STAGE 2 is attained when there is fusion of the calcificed points, forming
one or several cusps which unite to give a regularly outlined occlusal surface.
(For this and subsequent stages, carefully observe the characterisitic criteria for
each stage. Compare the tracing, the radiograph, and the osteological specimen).
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There are no apparent signs of calcification.
The formation of the crypt is not taken into consideration.
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For multiradicular teeth, STAGE1 is associated with the
beginning of calcification at the superior level of the cyrpt.
It takes the form of an inverted cone or cones.
There is no fusion of these calcified points.
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This stage may be identified by fusion of the calcified points to form one
or more cusps which unite to produce a regularly outlined occlusal surface.
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Demirjian System
Dental Calcification
Demirjian System
Dental Calcification
dents
uTypeDents
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Uniradiculaire
Uniradicular Teeth
Multiradiculaire
Multiradicular Teeth
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Gauche
Texte
This stage may be identified by fusion of the calcified points to form one
or more cusps which unite to produce a regularly outlined occlusal surface.rted cone or cones.
There is no fusion of these calcified points.aracterisitic criteria for
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Sample X-Rays
Dental Calcification
Sample X-Rays
Dental Calcification
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:PHYSSIZE
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me Demirjian
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OpenScript D
veloppement Dentaire
Septembre 1992
(c) Dr. Arto Demirjian
-- Auteur: Daniel L
veill
-- Revision: 11 Mars 1993
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SYLLABUS.TBK
3restauration
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Demand
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No signs of calcification are present.
The formation of the crypt is not taken into consideration.
This section gives the definition of the Demirjian System, with textual descriptions and visual exemples of each developmental stage....
Entrainement
This section will test your knowledge of dental growth with 378 questions on 54 X-Rays. Two module are offered to you: Beginner & Advanced..i
Bibliographie
This section contains 17 articles that can be read, scrolled through with abstracts, or even printed if you have access to a printer...
radio 1.5
This section shows the growth of a child from age 1.5 to 19 with a series of 21 panoramic X-Rays.
The radiographs are longitudinal between the ages of 6 and 15. In other words, X-Rays are of the same child taken over 10 consecutive years..utive years................e child taken over 10 consecutive years.
X-Rays..
valuationClinique
This section offers two different tools to calculate the dental age of a patient...
` AAAAAA
Demirjian System
Training
Bibliography
Sample X-Rays
Clinical Evaluation
DENTAL
DEVELOPMENT
DENTAL
DEVELOPMENT
boite
chapitres
"Menu"
messageSonore()
posFl
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posBoite(
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meDemirjian)
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3660,4515,6690,4935
posBoite(4)
3660,4140,6240,4560
posBoite(3)
3660,3735,5745,4155
posBoite(2)
3660,3330,5040,3750
posBoite(1)
3660,2910,6555,3330
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3045,4515
posFl
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radio 1.5
Bibliographie
Entrainement
meDemirjian
Credits
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7725,5805
CREDITSSS
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7725,6420
Licence
':PHYSSIZE
Licence
Dr. Arto Demirjian
Universit
de Montr
december 25th, 1992
TG3_2
TG3_6
TG6_3
Quitter
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8220,6675
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7035,6675
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meDemirjian
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sysDemirjian
Texte
DENTAL CALCIFICATION
The assessment of DENTAL CALCIFICATION, a refined scale for the evaluation of development, is based on shape changes in the dentition and therefore requires the use of a radiograph.
When the study of dental development is based on emergence (commonly confused with eruption), it is necessary to assess the clinical appearance of a tooth (i.e., the time when the tooth first pierces the gingival tissue).
The two primary disadvantages of using dental emergence when evaluating dental development are:
a) The difficulty and subjectivity in assessing the exact timing of dental emergence.
b) The lack of concensus in the literature concerning the exact definition of emergence.
The assessment of emergence is further limited by:
a) Dental Impaction - while impacted teeth continue to develop (calcify)
normally in the alveolar bone, their emergence cannot be evaluated.
b) Dental Crowding - crowding is associated with abnormal patterns of
emergence, even though calcification proceeds normally.
Dental maturation is assessed on a panoramic dental radiograph.
Periapical films can also be used for this purpose, if a panoramic X-Ray machine is not available. With a panorex film, the mandibular teeth on the left side are used for the ratings.
Separate criteria have been developed for UNIRADICULAR and MULTIRADICULAR teeth.
RATING OF DENTAL MATURATION
The permanent mandibular teeth of the left side are used for the ratings. If a tooth is missing, the corresponding tooth from the right-hand side is used.
The following order of assessment should be observed:
1) Second molar,
2) First molar,
3) Second bicuspid,
4) First bicuspid,
5) Cuspid,
6) Lateral incisor,
7) Central incisor.
All teeth are rated on a scale from 0 (A) to 8 (H).
Scores are assigned by comparing the tooth to the definition, the graphics and the X-Ray image of each stage.
The descriptions should be closely followed; the images are intended to serve as an aid, not as the primary basis for making comparisons.
The letters are added to show that on a chronological time scale, the stages are not equidistant from one another.
A stage may be defined by one (1), two (2), or three (3) criteria.
If only one criterion is given, it must be met in order to
consider that the stage has been attained.
If two criteria are given, then it is sufficient if the first of
the two is met.
If three criteria are given, any two of the three must be
met in order for the stage to be considered attained.
In addition to the criteria for each stage, all those of the previous stage(s) must have been satisfied as well.
The earlier of two stage should be assigned in borderline cases. Absolute measure-ments are not used in the assessments.
A pair of dividers is sufficient for the comparison of the lengths of the crown and root. Magnification is not necessary to determine apex closure stages; ratings should be made with the naked eye.
Crown height is defined as the maximum distance between the highest tip of the cusps and the cemento-enamel junction.
The midpoint between buccal and lingual cusps should be considered to beat the highest point when the cusps are not at the same level.
considered to be
at the highest point when the cusps are not at the same level.
DEVELOPMENTAL STAGES:
initialisation( Uniradiculaire )
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buttonUp
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buttonUp
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meDemirjian
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Multiradiculaire
Multiradicular Teeth
Demirjian System
Dental Calcification
Demirjian System
Dental Calcification
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Advanced
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From here you will choose an X-Ray from one of the 6 patients; for each X-Ray, you will evaluate the 7 teeth (37,36,35,34,33,32,31), one after the other.
You can change X-Rays at any time by clicking on the "Change X-Ray" button, or you can view the 9 X-Rays of that patient by clicking on the "Show all Ages" button.
avanc
This section takes completely control over what you will be questionned about. All you have to do is to answer the question.
When exiting, you will be given a score of your performance.
This chapter is designed to test your newly acquired knowledge of dental development.
It consist of 54 different X-Rays taken from 6 patients: 3 boys and 3 girls. These X-Rays were taken yearly between the ages of 6 and 14 years old.For each X-Ray shown, 7 teeth are indentified, for which you will be asked to choose the corresponding dental developmental stage.
The "Beginner" module gives you control on what you will be evaluating, while the "Advanced" module randomly selects the questions from a total of 378, until none are left.
unInstantSVP
One moment please...
( Loading X-Rays )
entrainement
aideBibliographie
meDemirjian
TG6_4
bibliographie
Bibliography
Indexental Calcification
Bibliography
Indexl Calcificationtion
CLICK ON THE ABSTRACT OF YOUR CHOICE.
No = 15
Barticle
/BiblioR
Page ( "R
" &No )
buttonUp
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BiblioR
article
1. A new system of dental age assessment, 1973.
2. Dental age estimation of children in forensic odontology, 1975.
3. New systems of dental maturity based on seven and four teeth, 1976.
4. Dentition in: Human Growth (1st ed.), 1978.
5. Dental development of British and French-Canadian children, 1979.
6. Dental development: A measure of physical maturity, 1980.
veloppement dentaire: Indice de maturit
physiologique, 1980.
8. The inter-examiner variation in rating dental formation from radiographs, 1980.
9. Sexual differences in dental development and prediction of emergence, 1980.
10. Sexual dimorphism in the development, emergence of the mandibular third molar, 1981.
11. L'
mergence des dents pr
molaires chez l'enfant canadien-fran
ais, 1981.
12. Teeth and dentition, 1984.
13. Sexual dimorphism in the emergence of the deciduous teeth, 1984.
14. Interrelationships among measures of somatic, skeletal, dental and sexual maturity, 1985.
15. Croissance et d
veloppement physique de l'enfant qu
cois de la naissance
six ans, 1985.
16. Dentition in: Human Growth (2nd ed.), 1986.
17. Sexual dimorphism in the emergence of deciduous teeth, 1986..86.
messageSonore()
Biblio
enterPage
enterPage
messageSonore
Biblio
bibliographie
TG5_8
TG3_4
valuationClinique
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valClinique
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calculAge dents, sexe
calculScore
score
calculMaturit
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calculScore
calculAge
calculMaturit
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messageSonore
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calculScore
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calculMaturit
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Clinical Evaluation
tal Calcification
Clinical Evaluation
nnnnnnnnnnnnnncation
stades
You have to specify the sex of the patient,
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Maturit
You have to specify the sex of the patient,
the Maturity Score.
valuationClinique
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Maturity Score -
This section gives you the choice of two different methods to calculate the Dental age:
Stades
RATES DENTAL AGEEE
Dental Age:
Score:
Score
Age dentaire
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stadeNo(sPM1)
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stadeNo(sM1)
stadeNo(sM2)
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stade(6)
stade(5)
stade(4)
stade(3)
stade(2)
stade(1)
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dentNo(I2)
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Second Premolar:ge:
First Premolar:Age:
Canine:Molar:l Age:
Lateral Incisor:ge:
Central Incisor:ge:
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Age dentaire
r$f$hilight
false
Clear
Maturit
MATURITY SCORE DENTAL AGE
Dental Age:::: Age:
Age dentaire
Score:Premolar:Age:
score
keyEnter
"8,48,49,50,51,52,53,54,55,56,57"
B"calcul"
"8,48,49,50,51,52,53,54,55,56,57"
message( errScoreLimite )
< 1 ) OR (
> 1000 )
keyUp
keyDown
keyChar
keyDown
8,48,49,50,51,52,53,54,55,56,57
keyUp
keyChar
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calcul
8,48,49,50,51,52,53,54,55,56,57
message
message
errScoreLimite
initialisation
[sexe
bouton
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buttonDown
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buttonDown
bouton
bouton
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Female
Calcul
bouton()
score
"Score"
message( errEvalScore )
"Age dentaire"
"7.3"
_Demo ) &
iDemoCalcul2 )
buttonUp
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Score
message
message
Age dentaire
message
message
DemoCalcul2
errEvalSexe
errEvalScore
score
CALCULATE
Effacer
initialisation
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"Score"
"Age dentaire"
buttonUp
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yinitialisation
Score
Age dentaire
<202C
L2hilight
false
Clear
sortie
-- Red
finie la nouvelle
si le bouton est d
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oboutonPresse
-- Place la fl
che en
originale.
4sAllerAide
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valuationClinique"
a propri
n fonction
-- du param
tre etatPresse qui peut
vrai ou faux.
H45,45
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buttonUp
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boutonPresse
buttonUp
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buttonUp
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valuationClinique
Maturit
Stades
Effacer
sAllerAide
boutonPresse
origines
etatPresse
7origines
4755,6675
EXIT
entrD
butant
posRx(14)
5940,5010
posRx(13)
3105,5010
posRx(12)
270,5010
posRx(11)
5940,2910
posRx(10)
3105,2910
posRx(9)
270,2910
posRx(8)
5940,810
posRx(7)
3105,810
posRx(6)
270,810
posRx
1680,945
patient
butant
Training
Beginnernnnnnnnnnnnnnnnnnnnn
Training
Beginner
textes
afficherQuestion
ponse
txtQuestion
afficherR
teindreTextes
afficherQuestion
afficherR
ponse
teindreTextes
afficherQuestion
txtQuestion
ponse
afficherR
ponse
ponse
txtQuestion
teindreTextes
txtQuestion
ponse
txtQuestion
Choose, from the following X-Rays, the dental development stage which corresponds to the identified tooth.
ponse
Choisir
The YELLOW square indicates the correct answer;
The RED one indicates the one you chose.
YELLOW
tousLesAges
4sBQSallum
BquestionSuivante
typeEntrainement()
tousLesAges
buttonUp
buttonUp
typeEntrainement
tousLesAges
questionSuivante
sBQSallum
Show all Ages
changeRx
4sBQSallum
typeEntrainement()
lection
buttonUp
buttonUp
typeEntrainement
lection
sBQSallum
Change X-Ray
Solution
solution
buttonUp
buttonUp
solution
Solution
Solution
mettreAjourSolution
4sQno
noRx
-1 ) DIV 7 ) +1
Qdent37
[laSolution;
dentNo
upperCase(
ponse( n )
D&"=" &L &", "
} -- le dernier ", "
mess( "Adulte" )
P" )
8&P(
6D" )
8&AD
mettreAjourSolution
mettreAjourSolution
ponse
Adulte
dentNo
laSolution
Qdent37
37=C, 36=F, 35=C, 34=D, 33=D, 32=F, 31=F
Score: 502 ; Dental Age: 6.7lt
lectionner
Choose a patient and then select an X-Ray.. X-Ray.
Choose a patient and then select an X-Ray.. X-Ray.
Patient
Patient #1#############1nnnnnnnnnnnnnnnnn
Patient #1ith Patient #11
patientNo
dessus
fond
dessus
dessus
pageSuivante
message( Demo ) &
Entr3 )
buttonUp
buttonUp
message
message
DemoEntr3
pagePr
dente
buttonUp
buttonUp
tousLesAges
The X-Ray outlined in red is the one you are evaluating...
Click the mouse to continue.
The X-Ray outlined in red is the one you are evaluating...
(.txt)